broad ligament hematoma hemorrhage

I had a broad ligament hematoma that caused internal bleeding.  It was found during the c-sec and pressure was applied for (medically speaking) “quite a while”.  My husband was told that the outlook was not optimistic.  But the bleeding thankfully stayed controlled and after several hours of close monitoring the danger had subsided.

  • The broad ligament extends from the sides of the uterus to the sides of the  pelvic walls and to the pelvic floor. The function of the broad ligament is to  hold the uterus in its normal position, helping maintain its relationship  relative to the Fallopian tubes and the ovaries.

Significance in Pregnancy

  • Problems with the broad ligament are most likely to occur during pregnancy.  Pregnancy can cause tension in the broad ligament, which can lead to hip or pelvic pain.

Read more:  Broad Ligaments and Pelvic Pain | eHow.com http://www.ehow.com/about_6518589_broad-ligaments-pelvic-pain.html#ixzz1vBW2KG2C

Hematoma of the broad ligament can be a potentially life-threatening condition.  According to eMedicine, common symptoms are back pain, fullness or pressure in  the recto-anal area, an urge to push or dizziness. Women may eventually develop  low blood pressure and anemia.
Read more:  Broad Ligaments and Pelvic Pain | eHow.com http://www.ehow.com/about_6518589_broad-ligaments-pelvic-pain.html#ixzz1vBVijyWM

Broad ligament hematoma is an unusual complication that can occur during delivery, just after delivery or later in the puerperium. Rapid labor, cesarean section, instrumental deliveries, and trauma have been suggested as predisposing factors.- http://www.springerlink.com/content/822047628pw42676/

Traumatic hematomas are rare and may be related to lacerations or may occur in isolation. They include vulvar and paravaginal hematomas in the lower genital tract and broad ligament and retroperitoneal hematomas adjacent to the uterus. Patients with lower genital tract hematomas usually present with intense pain and localized, tender swelling. Broad ligament hematomas may be palpated as masses adjacent to the uterus. All may result in significant blood loss that mandates resuscitation.

Order blood transfusions if blood loss is ongoing and thought to be in excess of 2000 mL or if the patient’s clinical status reflects developing shock despite aggressive resuscitation.

Pay close attention to the patient’s level of consciousness, pulse, blood pressure, and urine output during the course of the management of massive hemorrhage.

Broad ligament and retroperitoneal hematomas are initially managed expectantly if the patient is stable and the lesions are not expanding.[52] Ultrasound, CT scanning, and MRI all may be used to assess the size and progress of these hematomas. Selective arterial embolization may be the treatment of choice if intervention is required in these patients. Use surgical procedures to evacuate the hematoma, and attempt to tie off any bleeding vessels.http://emedicine.medscape.com/article/275038-treatment#aw2aab6b4b4

http://www.jultrasoundmed.org/content/22/1/69.full shows a “Broad ligament hematoma causing hydronephrosis: patient with a falling hematocrit level after cesarean delivery” that was treated conservitively and gradually receeded in a month.  but mine had to be treated agressively because of the hemodynamic state.

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